(3) Absence of another obvious cause of hypophosphatemia that is felt to account for the hypophosphatemia.The optimal cutoff is unclear, possibly an absolute serum phosphate level below ~1.5 mg/dL (0.5 mM). (2) Hypophosphatemia which occurs within three days of refeeding.(1) Cessation of nutrition followed by refeeding.Until a consensus definition is obtained, the following criteria seems reasonable: ( 29901461) Unfortunately, there is no uniform definition of refeeding syndrome. It seems logical to avoid administering insulin if possible (e.g., allowing glucose to rise to ~200-300 mg/dL).Insulin appears to play a central role in the generation of refeeding syndrome.More on how to calculate tube feeding rates here: □.For patients with the highest risk of refeeding syndrome, starting with 5 kcal/kg/day might even be considered (e.g., for a patient with BMI However, there is no high-quality evidence that this reduces the risk of refeeding syndrome. Many sources recommend starting conservatively (e.g., 50% energy requirement), with gradual advancement. Perhaps carbohydrates should initially be limited to Carbohydrate intake should probably be limited, because this stimulates an endogenous insulin surge which contributes to electrolyte depletion.Nutritional therapy to prevent refeeding syndrome Start vitamin B12 (cyanocobalamin) 1,000 micrograms PO daily.individual risk of refeeding syndrome and functionality of the gastrointestinal tract). Thus, the choice of IV versus PO may depend on clinical factors (e.g. ( 22305197) However, sufficient thiamine might not be absorbed rapidly enough for patients at the highest risk of refeeding syndrome. Some studies have demonstrated that the bioavailability of oral thiamine is substantial. It's unclear whether IV thiamine is absolutely required here, or whether oral thiamine would be adequate.Start thiamine prophylactically (e.g., thiamine 100-200 mg IV q12-q24hr).Check electrolytes (including magnesium and phosphate), with aggressive repletion as needed.Baseline low levels of K, Phos, or Mg.Catabolic state (e.g., due to infection or surgery).Malabsorption (e.g., inflammatory bowel disease, short gut syndrome, s/p bariatric surgery). Hyperemesis gravidarum or protracted vomiting.Abuse, neglect, inadequate access to food.Less time spent being underfed may still result in refeeding syndrome if the patient were under metabolic stress while not being fed (e.g., a postoperative patient).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |